Lacunar Stroke - Oren Zarif - Lacunar Stroke
Lacunar stroke affects the motor and sensory areas of the brain. Damage to the thalamus causes sensory loss, while an internal capsule destroys the brain tissue. Typically, symptoms are limited to one side of the body, and patients may experience weakness or wobbly gait. They usually do not experience facial paralysis. In some cases, the patient may not even show symptoms, depending on the severity of the damage.
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A stroke can occur anywhere in the body, but a lacunar stroke affects the brain's deep structures. Lacunar arteries are small, and branch directly from a large, heavily muscled artery. When high blood pressure is present, it can cause damage directly to the arteries and can also result in atherosclerosis, which causes fatty deposits in the walls of blood vessels. Because the brain is so complex, strokes in these regions are rare, but they are serious enough to require urgent medical care.
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Because the underlying pathology of small arteries is often diffuse, the risk of higher-level cortical dysfunction is lower than in those with a single lesion. Because lacunar stroke is more likely to occur in the lower regions of the brain, clinicians treating patients with this type of stroke should consider all participants at risk for cognitive impairment. A more complete understanding of how lacunar stroke affects the brain will help researchers understand why lacunar vascular disease affects cognition.
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Since most lacunes are not symptoms, they may represent markers of blood vessel disease in the brain. Although it is too early to determine if lacunes are caused by vascular disease, research into them may help in guiding public health initiatives to prevent strokes. Researchers found that hypertension significantly increased the risk of lacunes in older patients. Therefore, reducing blood pressure is a major part of stroke prevention programs. They also found that cigarette smoking and alcohol consumption decreased the incidence of lacunar stroke in patients with hypertension.
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Aside from age, smoking, diabetes mellitus, and alcohol consumption are risk factors for lacunar stroke. Despite the risk factors, patients with lacunar stroke generally recover from the injury and lead a productive life. However, some cases may result in subcortical dementia. There are several different ways to identify lacunar stroke. If a patient has a large, deep, or widespread lacunar infarct, an MRI may reveal the cause of the infarction.
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The first step in treating a lacunar stroke is to visit a medical professional. A doctor will ask about any symptoms that the patient has been experiencing. He or she may conduct a thorough neurological examination and may recommend medications. If the stroke is severe, a neurosurgeon may remove the clot or blockage from the brain. If treatment is delayed, the person may lose their ability to care for themselves. However, the patient can often recover with the right care.
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In rare cases, lacunar stroke may occur as a result of a small clot in the artery. These clots may affect blood flow for a few minutes, and then dissolve before permanent damage is done. In some cases, patients will not experience any symptoms. Symptoms may disappear completely or resolve within minutes. People with transient ischemic attacks usually recover completely within 24 hours. In the worst cases, people with lacunar stroke may require physical rehabilitation for years to come.
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In addition to these tests, MRI has the highest diagnostic accuracy in diagnosing lacunar infarcts. A diffusion-weighted MRI is also useful for distinguishing between chronic and acute lacunar infarct. Acute lacunes appear as focal areas of decreased signal intensity on T1 and T2 weighted images, whereas chronic lacunes have isointensity in CSF.
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Although the neurologic deficits caused by lacunar infarction are typically mild, physical rehabilitation remains essential after discharge. Patients with impaired mental or physical functions should follow their primary care provider's recommendations and take antiplatelet medications and take a statin to manage blood pressure. In addition, it is important to monitor blood sugar levels closely to prevent future strokes. Also, care coordination is essential after lacunar infarction.
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Infarcts involving a single penetrating artery account for approximately one quarter of all cerebral infarctions. Patients with lacunar infarcts often have a classical lacunar syndrome, which may be a result of an underlying medical condition. Hypertension, diabetes mellitus, and other conditions are major risk factors for lacunar infarctions. Because lacunar strokes are so small, the risk of death is low, although it can have profound consequences.